Changes Application Form - TPC 2563 - Adding Sun Room - 1/2 La Maison Neptune Circuit Noosaville · 51993.587.04

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                                                                                                                                       Departmentof Infrastructure, LocalGovernmentand Planr



91 Referral deta'is • Do any ilspects of the change application reqUire referral lor any reterral reqUirements?
Note      lilt-   J/,pIILllld,     /nil'"   [)t..   'd"'U(-f(1 to t",/(/)   fl;:!t''',I!                                                                     d!<IIIl}i::' ,lp'Jlll.-dtl,11I .~d, lilt, 0 "l,ndl
                                                                                       dyt.'llt.~ t!l(j~t.'l'tllJy t'lt' U/'/Ili}t:! d/Jphcd!JUfJ ,1:;." 111/1
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oNo
o Ves - the completed Sections 1 and 2 of Part 5 (Referral details) of DA Form 1 as it relates to the change application is
provided with this application. Where referral is required for matters relating to building wor!<the referral checklist for
building wor!< is also completed.


 1011"lulilldliufI H;quest under I-'arl J 01 the lJA Rules
o I agree to receive an information request if determined necessary for this change application
o I do not agree to accept an information request for this change application
Note: By not agreaing to acoopt an information request I. the applicant, acknowladge:
 •    that this changa application will be assessed and decided besed on the Information provided when making this change application
      and tha assassment manager and any referral egencias relevant to the chenge epplication ere not obllgatad under tha DA Rules to
      accept any additional information provided by tha appllcanl for the change application unless agreed to by the relevant partias
•     Part 3 of the DA Rules will stilt apply if the application is en application listed under section 11.3 oftha DA Rules.
Further advice about information requests is contained in tha DA Forms Guide.




D Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with this
application.


PART 6 - CHECKLIST AND APPLICANT DECLARATION
12) cil"f1ye applj{'~tiOl1 Checklist
I have identified the:
        •         responsible entity In 3); and
        •         for a minor change. any affected entities; and                                                                                                     []-Yes
        •         for an 'other' change ali relevant referral requlrement(s) In 9)
Nole: See the Planning Regulation 2017 for referral requirements
For an 'other' change application, the relevant sections of DA Form 1 - Development                                                                                  DVes
details have been completed and Is attached to this application                                                                                                      D Not applicable
For an 'other' change application. where building work is associated with the change
                                                                                                                                                                     DVes
application. the relevant sections of Form 2 - Building work details have been
                                                                                                                                                                     D Not applicable
completed and is attached to this application
Supporting information addressing any applicable assessment benchmar!<s Is attached
to this application
Note: This Includes any templates provided under 23.6) of DA Form 1 that are relevant as a
resun of the change application. a planning report and any technical reports required by the                                                                         rrYes
relevent cetegorising instrument(s} (e.g. the local government planning scheme, State Planning
Policy, State Development Assessment Provisions). For further information. see DA Eonus
Guide: Planning rePOrt template.
Relevant plans of the development are attached to this development application
Note: Relevant plans are required to be submitted for all relevant aspects of this change                                                                            [;}Yes
application. For further information, see DA Forms Guide: Relevant plans.




LJ ~ making this change application. I declare that all Information in this change application Is true and correct.
ITWhere an email address is provided In Part 1 of this form, I consent to receive future electronic communications from
the responsible entity and any relevan! affected entity or referral agency for the change application where written
Information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001.
Note: It Is unlawful to Intentionally provide false or misleading information.

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                                                                                                                                                           Planning Act Form 5 - Change appllcatlon fann
                                                                                                                                                                                Version U)-~ July 2017